Cited by 70Migraine and Headache StudiesPain Mechanisms and TreatmentsTraumatic Brain Injury Research

Pathophysiology of medication overuse headache: Insights and hypotheses from preclinical studies

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Meng, Ian D, Dodick, David, Ossipov, Michael H, Porreca, Frank·2011·Cephalalgia

Abstract

Introduction: Medication overuse headache (MOH) is a clinical concern in the management of migraine headache. MOH arises from the frequent use of medications used for the treatment of a primary headache. Medications that can cause MOH include opioid analgesics as well as formulations designed for the treatment of migraine, such as triptans, ergot alkaloids, or drug combinations that include caffeine and barbiturates. Literature review: Gathering evidence indicates that migraine patients are more susceptible to development of MOH, and that prolonged use of these medications increases the prognosis for development of chronic migraine, leading to the suggestion that similar underlying mechanisms may drive both migraine headache and MOH. In this review, we examine the link between several mechanisms that have been linked to migraine headache and a potential role in MOH. For example, cortical spreading depression (CSD), associated with migraine development, is increased in frequency with prolonged use of topiramate or paracetamol. Conclusions: Increased CGRP levels in the blood have been linked to migraine and elevated CGRP can be casued by prolonged sumatriptan exposure. Possible mechanisms that may be common to both migraine and MOH include increased endogenous facilitation of pain and/or diminished diminished endogenous pain inhibition. Neuroanatomical pathways mediating these effects are examined.

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Crossref · 10.1177/0333102411402367

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Authors
Meng, I. D., Dodick, D., Ossipov, M. H., & Porreca, F.
Affiliations
  • University of New England (US)
  • Mayo Clinic in Arizona (US)
  • University of Arizona (US)
Corresponding author
Porreca, Frank
Venue
Cephalalgia
Published
2011-03-28
Volume
31
Issue
7
Pages
851-860
ISSN
  • 0333-1024 (ISSN-L)
  • 1468-2982
OpenAlex
W1973686203
Cited by
70
References
101
Citations by year
2026: 3 · 2025: 4 · 2024: 4 · 2023: 3 · 2022: 7 · 2021: 7 · 2020: 8 · 2019: 3 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 1 · 2014: 5 · 2013: 6 · 2012: 6
FWCI
0.75
Type
journal article
Language
en
Open access
Locations
  • Cephalalgia (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Drug Abuse (DA029112, R01DA021193)
  • National Institute of Neurological Disorders and Stroke (R01NS069572)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
medication overuse headache, migraine, pathophysiology, cortical spreading depression, topiramate, paracetamol, sumatriptan, calcitonin gene-related peptide, chronic migraine, opioid analgesics, triptans, caffeine, barbiturates, endogenous pain inhibition
MeSH terms
Analgesics, Opioid, Humans, Migraine Disorders, Tryptamines, Headache Disorders, Secondary

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